Let’s start over.

Morgan Clendaniel makes a lot of sense.  Enough incremental garbage.  One way or the other, do something that is going to have an impact:

So, we need to forget free-market solutions, forget the public option. Enough marginal change. If someone is sick, they should get treated. Let’s accept that as our starting point and then figure out how to pay for it.

This is, of course, totally naive and politically nonviable. It also happens to be the right thing to do, and I’m confident that with enough smart people in the room, we could find a way to treat everyone. It’s really hard to argue that because something is too difficult to implement, we have to let people die, but that seems to be the point to which we’ve gotten ourselves.

Proving Innovation: Business Innovation Factory

The Business Innovation Factory is very cool:

An independent, non-profit organization launched in 2005, the Business Innovation Factory was founded to enable collaborative innovation. The BIF idea is simple: create a platform where public and private sector partners can collaborate across boundaries to focus on big win projects and deliver transformative innovations.

We believe that more organizations would innovate if they had access to a safer, more manageable environment to explore and test new ideas–a real world laboratory where organizations can keep current models producing while they design and test new ways of delivering value.

They call their work Innovation@Scale:

The only practical way to accelerate collaborative innovation is to test new business models in a smaller, more manageable environment. Given its location, size, and accessible public and private sector networks, Rhode Island’s unique ecosystem provides the optimal conditions to explore and test new business models. BIF offers members access to this unique innovation test bed, a capability we call Innovation@Scale.

Because of the never-offline/mistake-averse nature of health care, proving innovative ideas in manageable environments is a necessity.  It seems a practical model; one that would benefit a consortium of hospitals/health care organizations who may not independently have the resources for an innovation center.

As it happens, the BIF is working on the Nursing Home of the Future.  Read about it here.  Their pragmatic approach to solving problems is a welcome addition to the solving-health-care debate and provides a model to thinking about bettering the entire health care industry.

What we need are prairie dogs…

Dr. Richard Reece on vertical vs. lateral health care thinkers (via Kevin MD):

Vertical thinkers dig deeper and deeper holes across the health care landscape. At the bottom of each hole, you will find a world class expert. The only problem is the various vertical holes don’t connect. One specialist may not know what the other specialist is doing and may have no means of communicating with him/her colleagues or hospitals.

The lateral thinker, on other hand, roams the countryside looking for connections, seeking ways to put things together into an integrated whole, searching for a system blending relationships and eliminating care gaps, and hunting for self-organizing information platforms and disruptive innovations that lower costs and that work outside traditional specialty silos.

Read his very interesting (and spot-on) post.  It’s amazing how many of our problems we could solve with a proper focus on primary care.

Health care as a campaign issue

A terrific article in The Boston Globe over the weekend on health care as a campaign issue:

Healthcare is the sharp end of the stick of nearly every issue in the presidential campaign. And it has been for almost two decades.

Much of the health care debate focuses on the uninsured.  But increasingly the insured are having issues as well:

But what of the people who are insured, the ones who are trying to navigate through the red tape and the bureaucracy, the ones who fill out the forms and check all the boxes and scope out which providers are covered under which plans, the people whom the healthcare wonks call “the worried well”? For many of them, healthcare also means gasoline as well as pills, a T schedule as well as a prescription.

Widespread transformation efforts will begin when the majority of people in this country begin to realize that their health care system is on shaky ground.  Until then it’s a macro problem affecting everyone else.

Open Source Solutions

Taken in sum, our health care system is one big mess.

A closer look reveals a series of problems that together create it.

Looking microscopically we find the root causes of those problems.

These microscopic problems are only tiny in view of the big mess.  Microscopic problems are where individuals, small teams, and organizations can have significant impact on positive health care transformation.

It’s the sheer power of crowds.  A lot of people working on a lot of problems create a lot of solutions.

Easier said than done.  That’s why we need an agenda.  That’s why we give rewards for demonstrating success.

The New York Times reported on such an ideaInnoCentive is an open source solution finder.  The platform brings together seekers and solvers.  Seekers post problems.  Solvers solve them for a cash prize.

From the article:

That specificity is crucial to InnoCentive’s operation, people who have studied the company say. “If you say, ‘find me a cure for cancer’ it may not work,” Dr. Lakhani said. But if problems can be “decomposed” into what he called modular questions, like “find me a biomarker for this condition, these questions may be more tractable.”

InnoCentive has a global health category.  One seeker has broadly asked for “improvements to the United States health care system.”  That won’t work.

A dedicated platform should be created that focuses on specific improvements to the health care system.  Strategies to increase care coordination.  Communication improvements on medication directions.  Measures to better the process of medication reconciliation.

The list is endless.  But taken together, the power of the solutions would make a significant positive impact.

Health Advisory

We seek tax advice from accountants. We seek financial advice from financial planners. We seek health care advice from…well, doctors.

At least that’s the way it should be. But an overburdened system with underfunding in important high-advice areas like primary care, combined with misplaced financial incentives, make a physician’s time an especially scarce resource.

This usually means short visits with a provider for patients who are passive during appointments.

The internet, of course, is changing all of this through the emergence of Health 2.0.

We now can complete our tax returns online. We can invest using online services. Health care, however, has been slower to adapt. It still lacks the “killer-app” to make the internet truly industry altering.

The complexities of health care delivery are the reason for this slow adaptation—which is good. It allows for the opportunity to do it right, something especially important in this industry.

There are vasts amounts of information available on everything medicine. But it can be daunting for a patient not familiar with the intricacies of the industry. That should be okay, because a patient can search for information, collect and gather, and show up to an appointment armed with questions for a physician.

The breakdown in this Xanadu comes at the appointment. Physicians just don’t have the time to spend 30+ minutes with each patient. Fifteen minutes is pushing it.

But patients want to be informed. Read this post at Health Management Rx for an enlightening example.  Jen has written about the “middle eighty,” the constituency of patients in the middle.  The theory, adapted from sales, goes something like this: ten percent of patients are super-involved in their health care, ten percent of patients are completely passive, and the middle eighty percent is awaiting online tools to help them become more involved, but only after those tools have proved their value.

Targeting the “middle eighty” is where health care online will transform the industry.

The Associated Press wrote last week about a new service cropping up in health care to serve the “middle eighty,” albeit primarily offline.

In the vein of tax and financial advisory, health care advisers are beginning to solve patients’ health care headaches like finding a doctor and negotiating payment.  Organizations have been the primary purchasers of services thus far, mostly in an attempt to lower their health care coverage burden.

The recent trends in health care, including reduced employer support of health insurance and Medicare complexities, have forced the burden of managing health upon the “middle eighty.”  They’re being forced to become proactive in their health decisions.  And they’re looking for help.

The current service offering by these health care advisers is just a start. Once this industry moves to the online world with all that it has to offer–content, community, commerce and advisory to help a patient make sense of it all (coherence)–will it truly be industry altering.  Jen et al. call it Health 4.0. I call it health care transformed.

Transforming hospitals: from HR to Talent

Search any hospital/health system/practice group human resources job listings and you may realize the challenges in keeping a health care organization fully staffed. If not, search Google for nurse shortage, physician shortage, or read stories like this and this.

Trend: difficult human resources issues.

Some organizations are trying different kinds of benefits, others are trying referral programs, others are trying…

Those types of solutions may be important, but, turbulent times call for new solutions. Well, maybe it starts with Seth’s suggestion of renaming the department to Talent. It could be a difficult maneuver in the traditionally stodgy health care environment, but that’s the point here: this kind of disruption, this fundamental change in how we do business, how we approach opportunities and solutions, how we treat employees, has the potential to excite (it does for me!) people. Talk to someone who works at a new Pebble Project hospital and find out many people applied for the limited number of jobs: the facilities, ideas, and approach to care are different and that brings droves of applicants onto the scene.

But we don’t have to build a new hospital to approach health care in a different way.  Seth (as always thoughtful and completely insightful, and if you haven’t started reading his blog, you need to start, today) says:

Like it or not, in most organizations HR has grown up with a forms/clerical/factory focus. Which was fine, I guess, unless your goal was to do something amazing, something that had nothing to do with a factory, something that required amazing programmers, remarkable marketers or insanely talented strategy people.

Hmm, health care is an industry in deep trouble.  Thinking differently is going to help us get out of the mess: doing something(s!) amazing is the strategy.